214例动脉导管未闭的外科治疗

目的:回顾性分析214例先天性心脏病一动脉导管未闭的外科治疗,探讨不同手术方法的优缺点.方法:经左胸内PDA结扎术138例,经胸膜外PDA结扎术29例,自体氧合温血持续灌注心脏跳动中导管闭合术23例,深低温低流量体外循环导管闭合术21例,PDA切断缝合术3例.结果:左胸内PDA结扎术后再通4例,胸膜外PDA结扎术后无再通病例,自体氧合温血持续灌注心脏跳动中导管闭合术后死亡2例,深低温低流量体外循环导管闭合术后死亡1例,PDA切断缝合术后死亡1例.结论:15岁以下的病人可采用胸膜外导管结扎法,此法不进入胸膜腔,对肺干扰少,肺部并发症少;不置引流管,减轻病人痛苦.自体氧合沮血持续灌注心脏跳动中导管闭合术较深低温低流量体外循环导管闭合术有操作简单,避免了低温对人体生理机能的影响,术后并发症少,恢复快等优点,且能在术中明确房室瓣成形的效果.

SURGICAL TREATMENT FOR 214 CASES WITH PATENT DUCTUS ARTERIOSUS

AWe analysed reviewly 214 cases with paten t ductus arteriosus treated by surgical operation in order to inquire into the a dvantages and defects of the different surgical methods Method:The patent ductus arteriosus in 138 cases was ligated t hrough left thoracic cavity29 cases were ligated through extrapleur23 cases were sutured on beating heart which were perfused self warm blood continuously21 cases were sutured under deep hypothermia extracorporeal circulation3 cases were divised and sutured Result:ductus in 4 cases recanalizated again after closure of PDA through left thoracic cavityNo one recanalizated again after closure of PD A through extrapleur2 patients died after PDA were sutured on beating heart wh ich were perfused self warm blood continuously1 patient died after PDA was sut ured under deep hypothermia extracorporeal circulation1 case died after PDA wa s divised and sutured Conclusion:Our point was that patients who were less than 15 y ears will recover quickly if their patent ductus arteriosus was ligated through extrapleur because of little influence to lungs and Low lungs's complicationPa tients with complicated intracardiac malformation or pulmonary hypertension will be sutured on beating heart which were perfused with self warm blood continuous ly beccause of this method not only sample but bionoly function being avoided